Review: Benefits of antidepressants outweigh risks of suicidal ideation and attempts in children and adolescents.

摘要

In 2004, Hie FDA required a boxed warning for all antidepressant drugs regarding the increased risk of suicidal behaviour and ideation in children and adolescents based on an analysis of all available randomised, placebo-controlled trials (RCTs) of these drugs.1 Bridge and colleagues expanded this effort by re-examining this risk within the context of possible benefit. They collected data examining the use of antidepressant drugs across several indications. Although they used a slightly different subset of RCTs lhan previous FDA work, and a slightly different method for estimating risk, both reached a similar conclusion about the risk The contribution of the present paper is the estimates of benefit based on iheir metaanafysis of efficacy results. They concluded ihat efficacy "appears greatest for non-OCD anxiety disorders, iniermediate for.OCD, and more modest for MDD". Their quantification of risk and benefit in terms"bf NNH arid NKT is helpful in supporting their conclusion that the benefits outweigh the. risks across the range of disorders studied.The reported analysesare post hoc and caution is generally warranted in the interpretation of the findings. In addition, most of ihe RCTs are short term and thus cannot address longer-term benefits and risks. !t is, worth noting ihat adult maintenance trials wiifi antidepressants almost always show a benefit in maintaining treatment in responders. Furthermore, these data cannot provide valid comparisons between the individual drugs studied; some had smaller numbers of RCTs than others and consequently less of an opportunity to observe the risk or the benefit. Finally, dose effect was not explored.Although there remain differences of opinion about the reported risk and its implications for clinical practice, the evidence presented by Bridge and colleagues supports the FDA recommendations1 for ilie cautious and closely monitored use of antidepressant drugs in children and adolescents as a way to maximise me benefit and minimise the risk.